Concept of Operations: Relating to the introduction of a Personally Controlled Electronic Health Record System
B.1 General eHealth trends within Australia
Australia is one of the more information and communication technology enabled societies in the world. At the end of June 2009 there were 8.4 million active Internet subscribers in Australia, with 57% of subscribers having a download speed of 1.5Mbps or greater [ABS2009]. The existing Internet capability in Australia is able to support most current eHealth applications. Once implemented, the National Broadband Network will extend broadband support and facilitate new opportunities in eHealth.
The current healthcare system operates in a mixed mode of using paper-based and electronic-based systems for collecting and sharing health information. A number of different eHealth applications are in wide use in a number of different areas in the health sector including patient administration systems (PAS), clinical information systems (CIS), diagnostic imaging systems, pathology systems, practice management systems, etc.
The National E-Health Strategy noted during the consultation process that there is strong support for eHealth within Australia, and stakeholders recognise the potential efficiency, quality and many safety benefits it can deliver. Coupled with this widespread support, there was also a high degree of frustration with the pace of progress. In 2004, progress was too piecemeal and fragmented29, and lacked sufficient levels of investment and national coordination. This desire for a more nationally coordinated approach led to the creation of the National E-Health Strategy.
In terms of specific groupings, the following common themes are emerging across the community:
- States and territories: All state and territory governments are in the process of either defining or implementing some form of jurisdiction-wide eHealth strategy. These strategies typically involve substantial government investment on the upgrade of core IT infrastructure or the implementation of clinical information systems across the acute sector.
Common classes of systems in use in the states and territories include simple PASs used in smaller regional facilities to fully developed CISs capable of interfacing with emergency department, theatre booking, hospital pathology, radiology and hospital pharmacy systems. Most States and Territories are somewhere in between and may have different mixes of capabilities from health service to health service.
It should be noted that all states and territories are at different stages on their eHealth journeys. While they all use common classes of systems, they need to take specific approaches to solving their local challenges. However, these eHealth programs should result in the establishment of State and Territory eHealth platforms that provide the basis for integration with national infrastructure.
- General Practice: According to the Australian Medical Association (AMA), over 95% of GPs have computerised practice management systems. The majority of GPs with a computer at work used it for printing prescriptions, recording consultation notes, printing test requests and Referral letters and receiving results for pathology tests electronically. Roughly one third of GPs keep 100% of patient information in an electronic format and the remainder of general practices use a combination of paper and electronic records.
- Community Pharmacy: Anecdotal evidence indicates the uptake of systems within community pharmacies is quite high as it is a business necessity for pharmacists to manage their stock, dispense medicines, manage online claiming, create and maintain medication records and make use of evolving e-prescribing applications.
- Allied Health: Whilst there are some software packages available for managing allied health practices (e.g. around billing and bookings), anecdotal evidence indicates limited uptake of electronic health records in private allied health practices. Some public sector operated community health centres offer electronic health records for their allied health providers, but this is uncommon.
- Specialists: A Royal Australian College of Physicians survey of 1,266 Specialists found that 97.5% of respondents had access to computers at work [IMJ2009]. Most specialists are currently using practice management systems at their front desk for billing and booking; take-up of clinical systems within consulting rooms varies as much as 10% to 40% (depending on the speciality). A number of specialist systems are modified GP systems with additional modules added to support the needs of the specialist.
- Private Hospitals: There are a number of different products used across Private Hospitals, employed under different software implementations and underlying supported platforms. Their level of sophistication and function varies from simple PAS systems used to provide billing and booking in smaller day surgeries to fully developed CISs used in some of the not-for-profit groups. Outside of the not-for-profit hospitals, it is not uncommon for electronic health record systems to be operated mainly by specialists and the hospital mainly focuses on patient administration and theatre booking.
- Diagnostic Services: Private pathology and radiology providers have taken up ICT in order to be able to support their increasingly automated businesses and advanced diagnostic equipment. Pathology is one of the more advanced users of ICT and has a range of different vendors who supply systems into this space as well as supporting the delivery of electronic Pathology Result Reports. Similar levels of advanced usage are also seen in diagnostic imaging with a range of different vendors who supply both picture archive systems and radiology information systems into this space.
29 This view was also reflected in a report by the Boston Consulting Group (BCG) in 2004 [BCG2004]. The BCG undertook a system wide review of eHealth related activities across all jurisdictions in Australia. The review identified over 360 current or planned eHealth initiatives. The large majority (more than 70%) of these initiatives were small localised initiatives with a budget of less than $500,000.